Dual practice of public sector health care providers in

In Peru, medical practice has had private and public dimensions for a long time. Such arrangements have been regulated more by social consensus than by written rules. The traditional combination of public and private practices has produced a framework of few known interactions. Little is know about these interactions and little has been done to regulate them in Peru. To explore the extent, characteristics, incentives, effects and possible regulation of private medical practice in public facilities this study undertook a cross sectional quantitative – qualitative analysis. A close end questionnaire was randomly administered to 1173 doctors working at the Ministry of Health, the Peruvian Social Security (ESSALUD) and private health facilities placed in five departments of Peru (Lima, Huancavelica, Loreto, Piura and Tacna). Furthermore 26 in depth- interviews were made with doctors and key informants from Lima. Results from the survey and focus groups reveal that DP is mainly a strategy to obtain better incomes in the face of low public salaries. Furthermore this situation is influenced by th